Newly Diagnosed Outpatient Diabetes Case Study

CS is a 50 yr old female presenting to the outpatient diabetes clinic newly diagnosed with
T2DM. Diagnosed after presentation to the ED with blurry vision, polydipsia, and polyuria, with a
glucose of 600 mmol/L on labs.

History of GDM with daughters, now teenagers. Lost insurance, no other primary care. Family
History of HTN and HLP. Single mother, restaurant worker, late shifts.

The patient is unaware of where to begin with diabetic diet, has limited resources. She relies on
public transportation and the nearest grocery store 30 minutes away. Work hours limit her
exercise goals.

Vitals:
BP: 140/90
Temperature: 97.5oF
Respiration: 16
Pulse: 95

Anthropometrics:
Height: 5’2” (62”) (157.48 cm)
Weight: 70 kg (152 lbs)
Weight History:
6/27/2019 65 kg (143 lbs)
BMI: 27.8 kg/m2

Social History:
Cigarette Smoker: no
Cannabis Use: no
ETOH Use: Social, ~ one drink/week

Past Surgical History: None

Current Medications:
Women’s Multivitamin
Metformin = non-compliant

Recent Labs:
HBA1C: 12%
Glucose: 640 mmol/L
Total cholesterol: –
Sodium: -
Potassium: –
Magnesium: –
Phosphorus: –
BUN: –
Creatinine: -

24-hour Diet Recall:

Breakfast: McDonald’s large coffee with half cup of hazelnut creamer
Snack: Cheetos
Lunch: Hot dog, chips, gatorade
Dinner: Frozen mac n cheese, coca-cola, and two chocolate chip cookies

Calculate calorie goal/calorie needs:

Initial guidelines for MNT (Diabetes Standards of Care/Macro Distribution/ Carbs per day)

Discussion Questions Answers Prompt Questions

What initial lifestyle changes Typically patients have What interventions do

do you recommend to CS? individualized medical Registered Dietitians provide
nutrition therapy (MNT) goals. in T2DM in the outpatient
Most goals involve: setting?

1) Promotion of healthy What tools could you

eating patterns, improve recommend to use to help
overall health (such as weight manage her diabetes? (i.e.
maintenance, individualized carb counting apps,
blood sugar, blood pressure measuring cups for serving
and lipid goals, prevent any sizes, etc.)
further complications of
diabetes)
2) Individualize nutrition
needs per personal and
cultural preferences, health
literacy, accessibility to
healthy foods, willingness to
make lifestyle changes and
current barriers to change.
3) Providing non judgemental
science based messages
about food.
4)Delivering tools to develop
eating patterns. (American
Diabetes Association, 2021).

Increasing physical activity

outside of work might be
challenging due to her busy
schedule. However, since she
is up on her feet a lot at work,
that may contribute to her
daily physical activity.
Recommend 150 min/week of
moderate physical activity if
possible.

What are some barriers that
have prevented CS from
getting care that she needs?
Limited transportation
options decrease access to
grocery stores and increase
chances of eating at fast food
restaurants or getting
convenience foods.
What are some potential
solutions?
How can the healthcare team
work together to improve
these barriers?

Given CS’s financial and
transportation situations,
what would be a better meal
option for her to have?
Who would make up your
interdisciplinary team (IDT)?
How would you work in an
IDT to address this case
study?
What other concerns do you
have regarding this patient?
Lack of insurance makes it
difficult to see a PCP and
receive medications (insulin,
metformin)
Limited knowledge on
diabetes makes it harder to
understand complications
that can occur if continued to
be uncontrolled
Lack of time and facilities
to perform physical activity
outside of work.
Choosing healthier options at What macronutrient are we
fast food restaurants. concerned about with T2DM
Incorporate a protein with and why?
each meal/snack. Choosing
fruits/vegetables at meals MyPlate Method
and snacks. Options for
home delivery food.
IDT team will consist of an
APN, Registered Dietitian
who is certified as a diabetes
educator, Social Worker,
Medical Physician and a
psychiatrist.
The APN will prescribe the
necessary DM medication for
this patient. RDN will provide
additional diabetes education
and provide instruction on
monitoring insulin levels and
types of food to eat. Social
Worker to help aid with
finding insurance options and
talk about depression.
Psychiatrist will determine
whether the patient has
depression or other mental
health factors.
Risk of CVD, neuropathy, What comorbidities do you
nephropathy, retinopathy, think this patient may face if
future amputations the patient’s DM remains
uncontrolled?
 How do you think an earlier
prevention could have
prevented later events? Is
there another way you
would’ve handled this case?
Referral to Diabetes
Prevention Program or
individualized MNT (Evert,
A.B., Dennison M., Gardner
C.D., et al.,2019).
Think in terms of early
prevention and management,
What would you do?
It is statistically shown that
50% gestational diabetes will
turn into type 2 diabetes
(CDC, 2021)

Was there anything that we

discussed that surprised
you?

Any final thoughts?

References:
Alison B. Evert, Michelle Dennison, Christopher D. Gardner, W. Timothy Garvey, Ka Hei Karen
Lau, Janice MacLeod, Joanna Mitri, Raquel F. Pereira, Kelly Rawlings, Shamera Robinson,
Laura Saslow, Sacha Uelmen, Patricia B. Urbanski, William S. Yancy; Nutrition Therapy for
Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care 1 May 2019; 42 (5):
731–754. https://doi.org/10.2337/dci19-0014.

American Diabetes Association Professional Practice Committee; 5. Facilitating Behavior

Change and Well-being to Improve Health Outcomes: Standards of Medical Care in
Diabetes—2022. Diabetes Care 1 January 2022; 45 (Supplement_1): S60–S82.
https://doi.org/10.2337/dc22-S005.

Centers for Disease and Control (CDC). Carb Counting. Reviewed March 21, 2021. Accessed
January 27, 2022.
https://www.cdc.gov/diabetes/managing/eat-well/diabetes-and-carbohydrates.html.

Centers for Disease and Control (CDC). Diabetes Meal Planning. Reviewed March 21, 2021.
Accessed January 20, 2022.
https://www.cdc.gov/diabetes/managing/eat-well/meal-plan-method.html.

Centers for Disease and Control (CDC). Get Moving to Manage Your Diabetes. Reviewed
January 19, 2021. Accessed January 20, 2022.
https://www.cdc.gov/diabetes/library/features/get-moving-to-manage-diabetes.html.

Centers for Disease and Control (CDC). Gestational Diabetes. Reviewed August 10, 2021.
Accessed January 27, 2022. https://www.cdc.gov/diabetes/basics/gestational.html.